Drug regimens for adults with acute neuropathic pain managed in the community
For patients with acute neuropathic pain managed in the community, doses of oral adjuvants are titrated slowly to reduce the incidence of adverse effects; if an oral adjuvant is appropriate, use:
1 gabapentin 100 to 300 mg orally, at night initially. Increase to twice daily, then 3 times daily at 3-to 7-day intervals as tolerated and according to response. If needed, continue to increase the dose at 3-to 7-day intervals up to 3600 mg in 24 hours. If the patient is frail or older than 70 years, use the lower end of the dose range initially, titrate more slowly and do not exceed 900 mg in 24 hours1acute pain, neuropathic (in the community) gabapentin
OR
1 pregabalin 25 to 75 mg orally, at night initially. Increase to twice daily after 3 to 7 days. If needed, continue to increase the dose as tolerated and according to response, at 3-to 7-day intervals up to 600 mg in 24 hours. If the patient is frail or older than 70 years, use the lower end of the dose range initially, titrate more slowly and do not exceed 300 mg in 24 hours2 acute pain, neuropathic (in the community) pregabalin
OR
2 amitriptyline 5 to 12.5 mg orally, at night initially. Increase every 7 days, as tolerated and according to response, up to 50 mg at night. If no pain relief is achieved, discontinue treatment. If some pain relief is achieved, continue to increase the dose every 7 days, as tolerated and according to response, up to 150 mg at night. If the patient is frail or older than 70 years, use the lower end of the dose range initially and titrate more slowly acute pain, neuropathic (in the community) amitriptyline
OR
2 nortriptyline 5 to 12.5 mg orally, at night initially. Increase every 7 days, as tolerated and according to response, up to 50 mg at night. If no pain relief is achieved, discontinue treatment. If some pain relief is achieved, continue to increase the dose every 7 days, as tolerated and according to response, up to 150 mg at night. If the patient is frail or older than 70 years, use the lower end of the range initially and titrate more slowly acute pain, neuropathic (in the community) nortriptyline
OR
2 duloxetine 30 mg orally, in the morning. Increase every 7 days, as tolerated and according to response, up to 120 mg in the morning acute pain, neuropathic (in the community) duloxetine
OR
2 venlafaxine modified-release 37.5 to 75 mg orally, in the morning. Increase every 7 days, as tolerated and according to response, up to 225 mg in the morning. acute pain, neuropathic (in the community) venlafaxine